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Primary Hyperparathyroidism — RACP Adult Medicine MCQ

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HardEndocrinology & DiabetesPrimary HyperparathyroidismRACP Adult Medicine

A 55-year-old man is found to have a serum total calcium of 2.85 mmol/L and a PTH of 95 pg/mL (mildly elevated). His calcium has been consistently elevated at 2.70–2.90 mmol/L over 3 measurements. He has no symptoms, no kidney stones, and DEXA shows T-score -1.5. His eGFR is 72 mL/min/1.73 m². He is 52 years old. According to current guidelines, does he meet criteria for parathyroidectomy?

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Correct answer: E — Yes – calcium >0.25 mmol/L above upper limit is a surgical indication

Indications for parathyroidectomy in asymptomatic primary hyperparathyroidism include: serum calcium >0.25 mmol/L above upper limit of normal (~2.85 mmol/L if ULN is 2.60), T-score ≤ -2.5 at any site, vertebral fracture, eGFR <60 mL/min/1.73 m², kidney stones/nephrocalcinosis, or age <50. This patient's calcium of 2.85 mmol/L is ≥0.25 mmol/L above the ULN (2.60), meeting surgical criteria. He should be referred for consideration of parathyroidectomy.

Reference: eTG – 2025 – Endocrinology; Fourth International Workshop on PHPT – 2014